TIGER SOCCER CAMP REGISTRATION- 2012

You may sign up for youth soccer camp at any time during the year, just mail in this form and money to:
       Jason Herbert
       c/o Tiger Soccer Camp
       605 Garden Pkwy
       Circleville, OH .
Camp is for Boys & Girls Ages 5-14 (July 30-Aug.2, 2012)

2012 Camp Fee: $10         (Make payable to: Circleville Athletic Boosters)
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Name ______________________________

Address ____________________________________________

Emergency Contact Phone Number ______________________

T-shirt size   YS      YM       YL       AS       AM       AL       XL

CURRENT AGE ________

M______  or     F_______
                                                         Emergency Medical Waiver
As parent or legal guardian, I fully agree to allow my child to participate in TIGER SOCCER
CAMP and hereby promise not to hold CYSA or Circleville City School, either of their officers, directors, volunteers, paid staff,
or other individuals or entities associated with the camp or CYSA/CCS liable for any injury that may arise
as a result of, or incidental to, participation of camp.

Parent Signature _______________________________

Print Name _____________________________________

Date ______________________
 
For more info. contact: Jason Herbert
                                       740.497.8575
                                       jason.herbert@cvcsd.com